October 12, 2001

 

 

MB-AASA-HCS/AAA-RCS-DDD-01-46

MANAGEMENT BULLETIN

 

 

TO:                 Area Agency on Aging (AAA) Directors

                        Home & Community Services (HCS) Regional Administrators

                                                           

SUBJECT:   REVISED AUTHORIZATION TO RELEASE/OBTAIN HEALTH CARE INFORMATION

 

The attached Authorization to Release/Obtain Health Care Information replaces DSHS 09-855(x) (7/1997) Authorization to Release/Obtain Information.  The revised form complies with the following state and federal regulations: 

 

42 CFR Part 2        Confidentiality of Alcohol and Drug Abuse Patient Records

RCW 70.02.030       Medical Records

RCW 74.04.060       General Provisions—Administration, Records, Confidential, Exceptions

RCW 71.05.620       Mental Health records

RCW 70.24.105       HIV/AIDS/STDs

 

How do I access the form?

 

English version:  To obtain publication number DSHS 09-8555(X) revision 6/01:

·        Submit your order to DSHS Warehouse, Mail Stop 45816; or

·        Fax your order at 360-664-0597; or

·        Access a .pdf file on the DSHS intranet or order the form on line at http://asd.dshs.wa.gov/html/oar_forms.htm or the DSHS internet at http://www.dshs.wa.gov/dshsforms/index.html.  There are clear instructions on how to download the form on the sites.

 

The English version hard copy is printed on NCR paper so that our clients can receive an immediate copy of the completed form.  Use carbon paper to give the client an immediate copy generated from the pdf file.

 

Languages:  Spanish, Russian, Korean, Chinese, Vietnamese, Laotian, and Cambodian translated forms are printed as needed on bond paper.  Follow the previous instructions to submit an order for translated versions of the form.

 

What are the revisions?

 

  1. The time the form is effective is changed to one year instead of 90 days, coinciding with the case management annual review timeline. 
  2. The name of the form is changed to “Authorization to Release/Obtain Health Care Information to reflect the priority of the form.
  3. Section 1 includes multiple areas to list all entities involved in the client’s assessment and service plan development process obtained during the initial client assessment.  Note that there is a checkbox for the specific type of information sought, as the client has the right to know the type of information being released, who is being contacted and why (See 42 CFR Part 2, RCW 70.02.030, RCW 71.05.620 and RCW 70.24.105).  Additional releases need to be obtained for future entities involved in the case.  The client must initial the box where designated to indicate permission to release the information.
  4. When searching for an adult family home or boarding home, the client may not wish to disclose ALL information to an array of potential providers.  Section 3 allows the client to choose what information s/he wants to release to potential providers.  The client must specify what information can be released by checking the information to be released and initialing the box.  When sharing information with potential providers to determine an appropriate living situation, it is not necessary to complete section 1 if section 3 is completed.
  5. The ‘witness’ signature box was removed from the signature areas.  Witnesses are not needed; the case manager/social worker’s signature on the form is sufficient.

 

When do I have an Authorization to Release/Obtain Health Care Information form signed?

 

You must obtain a signed form anytime you need to release information to health care providers, family members, landlords, financial institutions, or any other persons or agencies who act as collateral sources in the course of determining eligibility or managing a case.  Although you can accept information from other health care providers, agencies and other persons without a signed form, you need a signed form to exchange information.  Also, use the Authorization to Release/Obtain Health Care Information form to request information from health care providers, institutions, agencies, and other persons.

 

As stated in the question above, section 1 provides multiple spaces to write the names of all those with whom you may need to exchange or obtain information.  If you need to talk to additional entities after the client signed and dated the original form, another form with the individual/entity’s information must be signed. 

 

Are there other situations where I would have an Authorization to Release/Obtain Health Care Information signed by the client?

 

You can document information regarding a client’s HIV/AIDS/STD status in the Comprehensive Assessment (CA), Service Plan (SP) or Service Episode Record (SER) if you have express permission from the client.  To obtain client permission, you must fully complete the Authorization to Release/Obtain Health Care Information form.  This means that in order to document HIV/AIDS/STD information, the client must initial the appropriate sections of the form (Sections 1 & 3) and sign and date the form.

 

When do I get the release signed by clients with diagnoses of HIV/AIDS/STD?

 

For new clients:  Before completion of the CA and the development of the SP, you must have the client sign the Authorization to Release/Obtain Health Care Information form.

For existing clients:  You must have the client sign the form at the time of reassessment (annual or significant change).  Until the time of reassessment, consult with your local public disclosure coordinator before disclosing any HIV/AIDS/STD information that has already been documented in the client’s files (CA, SP, or SER).

 

What if the client does not want HIV/AIDS/STD information documented in the CA, SP or SER?

 

Per Administrative Policy 6.09, the department must maintain strict confidentiality of information about clients diagnosed with HIV disease, AIDS or STDs, since such information is medical in nature, personal and confidential.  Furthermore, you must not document such information unless the client authorizes.  Documentation of HIV/AIDS/STDs without release could lead to unauthorized disclosure, which is a gross misdemeanor under RCW 70.24.080 and could subject the department to a lawsuit or civil penalties (RCW 70.24.084).

 

If all providers or collateral contacts are not known at the initial assessment, can I have the client sign and date the form and enter the names in later?

 

No.  All laws pertaining to the release of confidential information (see previous list of relevant citations) state a person’s signature indicates permission to release:

  1. specifically named information
  2. to a specific person or entity
  3. listing why the information is needed; and
  4. how long the information can be released.

Having a client sign a blank release does not comply with the laws.

 

Do I HAVE to use form DSHS 09-855 (X)?

 

Yes.  All HCS and AAA staff must use DSHS 09-855(X), which contains all federally required language.

 

Inquiries:      Carol Sloan, Program Manager

                        Home & Community Programs

                        360-725-2345, fax:  360-438-8633

                        sloancs@dshs.wa.gov

 

 

 

                                                                        ______________________________

                                                                        Penny Black, Director

                                                                        Home & Community Services Division

 

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